Provider Demographics
NPI:1871854653
Name:BINGHAM, ANNA N (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:N
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-3503
Mailing Address - Country:US
Mailing Address - Phone:870-210-6550
Mailing Address - Fax:448-350-4173
Practice Address - Street 1:416 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-6144
Practice Address - Country:US
Practice Address - Phone:870-210-6550
Practice Address - Fax:844-350-4173
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1510120101YP2500X, 101YP2500X
ARA1310125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor